Provider Demographics
NPI:1386893303
Name:MEDICRUISER, LLC
Entity type:Organization
Organization Name:MEDICRUISER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:M
Authorized Official - Last Name:GAHLINGER
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PHD
Authorized Official - Phone:801-484-5504
Mailing Address - Street 1:1850 SO. 300 WEST
Mailing Address - Street 2:STE A
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84115-2399
Mailing Address - Country:US
Mailing Address - Phone:801-484-5504
Mailing Address - Fax:801-484-5538
Practice Address - Street 1:1850 S 300 W
Practice Address - Street 2:STE A
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84115-2398
Practice Address - Country:US
Practice Address - Phone:801-484-5504
Practice Address - Fax:801-484-5538
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-15
Last Update Date:2008-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care